961 resultados para Non-leaving face property
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La thérapie antirétrovirale prévient la transmission mère-enfant du VIH dans plus de 98% des cas lorsqu’administrée pendant la grossesse, le travail et au nouveau-né. L’accessibilité à la thérapie antirétrovirale dans près de 70% des 1,5 millions cas de grossesses VIH+ dans le monde mène à la naissance de plus d’un million d’enfants exposés non infectés chaque année. Le nombre d’enfants exposés non infectés est à la hausse ainsi que les préoccupations concernant leur santé. En effet, plusieurs groupes ont signalé une augmentation de la morbidité et de la mortalité chez les enfants exposés non infectés. L’analyse des données rétrospectives de 705 enfants exposés non infectés de la cohorte mère-enfant du CMIS a révélé qu’à 2 mois d’âge, les enfants nés de mères ayant une charge virale supérieure à 1,000 copies d’ARN / ml avaient une fréquence de lymphocytes B significativement plus élevés par rapport aux enfants exposés non infectés nés de mères ayant une charge virale indétectable. L’objectif de cette étude est de caractériser ces anomalies. Les lymphocytes, provenant du sang de cordon ombilical et de sang veineux obtenu à 6 et 12 mois d’âge, ont été phénotypés par cytométrie en flux à l’aide des marqueurs CD3 / CD10 / CD14 / CD16 / CD19 / CD20 / CD21 / CD27 / IgM pour les lymphocytes B et CD4 / CD8 / CD3 / CCR7 / CD45RA pour les lymphocytes T. De plus, afin d’étudier les capacités fonctionnelles des lymphocytes B CD19+, la réponse antigène-spécifique au vaccin antitétanique a été mesurée par marquage avec des tétramères fluorescents de fragment C du toxoïde tétanique. Nos travaux ont mis en évidence des différences statistiquement significatives entre les enfants exposés non-infectés (ENI) nés de mères avec une charge virale détectable comparativement à ceux nés de mères avec une charge virale indétectable. À la naissance, les enfants ENI nés de mères avec une charge virale détectable avaient significativement moins de lymphocytes B totaux, plus de lymphocytes B mémoires classiques, activés, plasmablastes et lymphocytes T CD8+ mémoires centrales. À 6 mois, ils avaient significativement plus de lymphocytes B naïfs et significativement moins de lymphocytes T CD8+ effecteurs mémoires. À 12 mois d’âge, ils avaient significativement plus de lymphocytes B et T CD8+ totaux; significativement moins de lymphocytes T CD4+ totaux et leurs lymphocytes T affichaient un profil significativement plus activé (plus de cellules mémoires). L’analyse de la réponse antigène-spécifique a révélé une fréquence plus élevé de lymphocytes B mémoires IgM+ suggérant que les enfants nés de mères avec une virémie détectable ont plus de mal à établir une mémoire immunitaire efficace face au vaccin antitétanique. Nos données suggèrent qu’il y a exposition durant le premier trimestre de grossesse à la virémie maternelle et que cette exposition impacte le système immunitaire en développement du fœtus. Les mécanismes sous-jacents causant ces anomalies doivent encore être élucidés et l’épuisement du compartiment T à la naissance et à 6 mois reste à être investigué. Dans un pays industrialisé où l’accès aux soins est facilité, ces anomalies ont des conséquences modérées mais dans des pays à faible et moyen revenu, les conséquences peuvent être beaucoup plus tragiques voir fatales.
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Ce mémoire porte sur le rôle des cercles abolitionnistes dans l’application des lois sur l’émancipation graduelle de l’esclavage dans le nord des États-Unis vers la fin du dix-huitième siècle, principalement à New York et en Pennsylvanie. Plus particulièrement, il met en lumière la façon dont ces cercles, dont les deux plus importants étaient la Pennsylvania Abolition So-ciety (PAS) et le NewYork Manumission Society (NYMS), ont fait face aux centaines de réfugiés de Saint-Domingue qui sont arrivés avec leurs esclaves sur la côte est américaine pour fuir la révolution haïtienne dans les années 1790. Dans un premier temps, ce mémoire étudie l’abolition graduelle de l’esclavage dans le nord des États-Unis, débutant avec la Pennsylvanie en 1780, et la formation des cercles abolitionnistes dans les anciennes colonies anglaises. Il sera en outre question des stratégies des antiesclavagistes américains afin de promouvoir l’abolition graduelle de l’esclavage et d’empêcher le mouvement des esclaves et des noirs libres en dehors des frontières de leurs États respectifs. Il sera aussi question de leurs efforts pour resserrer davantage les clauses des lois existantes à ce sujet. Dans un second temps, dans le but de mettre en relief la contribution des cercles abolitionnistes, ce mémoire procède à une étude de cas sur la manière dont les réfugiés de Saint-Domingue ont interagi avec l’esclavage résiduel à New York et en Pennsylvanie et cherche à comprendre pourquoi leurs tentatives d’échapper aux lois sur l’émancipation graduelle se sont heurtées, à plusieurs reprises, aux stratégies des sociétés antiesclavagistes.
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Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica
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Speech perception routinely takes place in noisy or degraded listening environments, leading to ambiguity in the identity of the speech token. Here, I present one review paper and two experimental papers that highlight cognitive and visual speech contributions to the listening process, particularly in challenging listening environments. First, I survey the literature linking audiometric age-related hearing loss and cognitive decline and review the four proposed causal mechanisms underlying this link. I argue that future research in this area requires greater consideration of the functional overlap between hearing and cognition. I also present an alternative framework for understanding causal relationships between age-related declines in hearing and cognition, with emphasis on the interconnected nature of hearing and cognition and likely contributions from multiple causal mechanisms. I also provide a number of testable hypotheses to examine how impairments in one domain may affect the other. In my first experimental study, I examine the direct contribution of working memory (through a cognitive training manipulation) on speech in noise comprehension in older adults. My results challenge the efficacy of cognitive training more generally, and also provide support for the contribution of sentence context in reducing working memory load. My findings also challenge the ubiquitous use of the Reading Span test as a pure test of working memory. In a second experimental (fMRI) study, I examine the role of attention in audiovisual speech integration, particularly when the acoustic signal is degraded. I demonstrate that attentional processes support audiovisual speech integration in the middle and superior temporal gyri, as well as the fusiform gyrus. My results also suggest that the superior temporal sulcus is sensitive to intelligibility enhancement, regardless of how this benefit is obtained (i.e., whether it is obtained through visual speech information or speech clarity). In addition, I also demonstrate that both the cingulo-opercular network and motor speech areas are recruited in difficult listening conditions. Taken together, these findings augment our understanding of cognitive contributions to the listening process and demonstrate that memory, working memory, and executive control networks may flexibly be recruited in order to meet listening demands in challenging environments.
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Conventional rockmass characterization and analysis methods for geotechnical assessment in mining, civil tunnelling, and other excavations consider only the intact rock properties and the discrete fractures that are present and form blocks within rockmasses. Field logging and classification protocols are based on historically useful but highly simplified design techniques, including direct empirical design and empirical strength assessment for simplified ground reaction and support analysis. As modern underground excavations go deeper and enter into more high stress environments with complex excavation geometries and associated stress paths, healed structures within initially intact rock blocks such as sedimentary nodule boundaries and hydrothermal veins, veinlets and stockwork (termed intrablock structure) are having an increasing influence on rockmass behaviour and should be included in modern geotechnical design. Due to the reliance on geotechnical classification methods which predate computer aided analysis, these complexities are ignored in conventional design. Given the comparatively complex, sophisticated and powerful numerical simulation and analysis techniques now practically available to the geotechnical engineer, this research is driven by the need for enhanced characterization of intrablock structure for application to numerical methods. Intrablock structure governs stress-driven behaviour at depth, gravity driven disintegration for large shallow spans, and controls ultimate fragmentation. This research addresses the characterization of intrablock structure and the understanding of its behaviour at laboratory testing and excavation scales, and presents new methodologies and tools to incorporate intrablock structure into geotechnical design practice. A new field characterization tool, the Composite Geological Strength Index, is used for outcrop or excavation face evaluation and provides direct input to continuum numerical models with implicit rockmass structure. A brittle overbreak estimation tool for complex rockmasses is developed using field observations. New methods to evaluate geometrical and mechanical properties of intrablock structure are developed. Finally, laboratory direct shear testing protocols for interblock structure are critically evaluated and extended to intrablock structure for the purpose of determining input parameters for numerical models with explicit structure.
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International Relations theory would predict that central governments, with their considerable material resources, would be unlikely to face a challenge from a substate government. However, substate governments, and particularly Indigenous governments, are pushing back against central government control in both domestic and international spheres. Indigenous governments are leveraging their local mining sectors to realize their interests and express local identities—interests and identities that may not be congruent with those of the central government. Applying the case study of the resource extraction sector in Canada, this thesis asks: under what conditions are substate governments able to challenge the authority of central governments in the international arena? Canada’s reliance on the global extractive resource sector is a major driver of its international policy preferences, but the increased engagement of Indigenous governments in the sector challenges the control of the federal government. Focusing on the resource extraction sectors in British Columbia, Saskatchewan, and Ontario, this thesis argues that there is a mutually reinforcing relationship between Indigenous governments’ international engagement and their domestic autonomy; both challenge the parameters of state authority. Both force the state to respond to claims of control from multiple sites and to clarify convoluted policy environments. A confluence of factors—including increased Indigenous connections to the globalized economy, new Canadian regulatory frameworks, and recent Supreme Court of Canada cases regarding Indigenous lands—have all altered the space in which Indigenous governments in Canada participate in the resource extraction sector and produce overlapping or multilevel governance structures. This thesis demonstrates that Indigenous international engagement entrenches the authority and political legitimacy manifest in Indigenous governments’ insistence on equitable and horizontal negotiations in Canada’s lucrative resource extraction sector. A cumulative process occurs in which domestic and international expressions of political autonomy reinforce each other, produce further opportunities to express authority in both environments, and trouble the state’s capacity to fully realize its international policy preferences.
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This research develops an econometric framework to analyze time series processes with bounds. The framework is general enough that it can incorporate several different kinds of bounding information that constrain continuous-time stochastic processes between discretely-sampled observations. It applies to situations in which the process is known to remain within an interval between observations, by way of either a known constraint or through the observation of extreme realizations of the process. The main statistical technique employs the theory of maximum likelihood estimation. This approach leads to the development of the asymptotic distribution theory for the estimation of the parameters in bounded diffusion models. The results of this analysis present several implications for empirical research. The advantages are realized in the form of efficiency gains, bias reduction and in the flexibility of model specification. A bias arises in the presence of bounding information that is ignored, while it is mitigated within this framework. An efficiency gain arises, in the sense that the statistical methods make use of conditioning information, as revealed by the bounds. Further, the specification of an econometric model can be uncoupled from the restriction to the bounds, leaving the researcher free to model the process near the bound in a way that avoids bias from misspecification. One byproduct of the improvements in model specification is that the more precise model estimation exposes other sources of misspecification. Some processes reveal themselves to be unlikely candidates for a given diffusion model, once the observations are analyzed in combination with the bounding information. A closer inspection of the theoretical foundation behind diffusion models leads to a more general specification of the model. This approach is used to produce a set of algorithms to make the model computationally feasible and more widely applicable. Finally, the modeling framework is applied to a series of interest rates, which, for several years, have been constrained by the lower bound of zero. The estimates from a series of diffusion models suggest a substantial difference in estimation results between models that ignore bounds and the framework that takes bounding information into consideration.
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Recent developments have made researchers to reconsider Lagrangian measurement techniques as an alternative to their Eulerian counterpart when investigating non-stationary flows. This thesis advances the state-of-the-art of Lagrangian measurement techniques by pursuing three different objectives: (i) developing new Lagrangian measurement techniques for difficult-to-measure, in situ flow environments; (ii) developing new post-processing strategies designed for unstructured Lagrangian data, as well as providing guidelines towards their use; and (iii) presenting the advantages that the Lagrangian framework has over their Eulerian counterpart in various non-stationary flow problems. Towards the first objective, a large-scale particle tracking velocimetry apparatus is designed for atmospheric surface layer measurements. Towards the second objective, two techniques, one for identifying Lagrangian Coherent Structures (LCS) and the other for characterizing entrainment directly from unstructured Lagrangian data, are developed. Finally, towards the third objective, the advantages of Lagrangian-based measurements are showcased in two unsteady flow problems: the atmospheric surface layer, and entrainment in a non-stationary turbulent flow. Through developing new experimental and post-processing strategies for Lagrangian data, and through showcasing the advantages of Lagrangian data in various non-stationary flows, the thesis works to help investigators to more easily adopt Lagrangian-based measurement techniques.
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The main objective of blasting is to produce optimum fragmentation for downstream processing. Fragmentation is usually considered optimum when the average fragment size is minimum and the fragmentation distribution as uniform as possible. One of the parameters affecting blasting fragmentation is believed to be time delay between holes of the same row. Although one can find a significant number of studies in the literature, which examine the relationship between time delay and fragmentation, their results have been often controversial. The purpose of this work is to increase the level of understanding of how time delay between holes of the same row affects fragmentation. Two series of experiments were conducted for this purpose. The first series involved tests on small scale grout and granite blocks to determine the moment of burden detachment. The instrumentation used for these experiments consisted mainly of strain gauges and piezoelectric sensors. Some experiments were also recorded with a high speed camera. It was concluded that the time of detachment for this specific setup is between 300 and 600 μs. The second series of experiments involved blasting of a 2 meter high granite bench and its purpose was the determination of the hole-to-hole delay that provides optimum fragmentation. The fragmentation results were assessed with image analysis software. Moreover, vibration was measured close to the blast and the experiments were recorded with high speed cameras. The results suggest that fragmentation was optimum when delays between 4 and 6 ms were used for this specific setup. Also, it was found that the moment at which gases first appear to be venting from the face was consistently around 6 ms after detonation.
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With progressive climate change, the preservation of biodiversity is becoming increasingly important. Only if the gene pool is large enough and requirements of species are diverse, there will be species that can adapt to the changing circumstances. To maintain biodiversity, we must understand the consequences of the various strategies. Mathematical models of population dynamics could provide prognoses. However, a model that would reproduce and explain the mechanisms behind the diversity of species that we observe experimentally and in nature is still needed. A combination of theoretical models with detailed experiments is needed to test biological processes in models and compare predictions with outcomes in reality. In this thesis, several food webs are modeled and analyzed. Among others, models are formulated of laboratory experiments performed in the Zoological Institute of the University of Cologne. Numerical data of the simulations is in good agreement with the real experimental results. Via numerical simulations it can be demonstrated that few assumptions are necessary to reproduce in a model the sustained oscillations of the population size that experiments show. However, analysis indicates that species "thrown together by chance" are not very likely to survive together over long periods. Even larger food nets do not show significantly different outcomes and prove how extraordinary and complicated natural diversity is. In order to produce such a coexistence of randomly selected species—as the experiment does—models require additional information about biological processes or restrictions on the assumptions. Another explanation for the observed coexistence is a slow extinction that takes longer than the observation time. Simulated species survive a comparable period of time before they die out eventually. Interestingly, it can be stated that the same models allow the survival of several species in equilibrium and thus do not follow the so-called competitive exclusion principle. This state of equilibrium is more fragile, however, to changes in nutrient supply than the oscillating coexistence. Overall, the studies show, that having a diverse system means that population numbers are probably oscillating, and on the other hand oscillating population numbers stabilize a food web both against demographic noise as well as against changes of the habitat. Model predictions can certainly not be converted at their face value into policies for real ecosystems. But the stabilizing character of fluctuations should be considered in the regulations of animal populations.
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La radicalité du changement culturel provoque une crise de la forma ecclesiae et introduit la question relative à quelle est la forme de l’Église la plus appropriée à l’annonce de l’évangile. L’Église italienne, que le présent travail a l’intention d’assumer en qualité de point de référence particulier, en est également intéressée: contrairement au passé, même le plus récent, la foi chrétienne n’est plus un patrimoine «de tous». La question se pose puisque, au nom de l’évangile, l’action de l’Église ne peut pas disperser, pourtant, le caractère universel de la foi en soi même (son être «pour tous»). Dans un tel scénario, s’enclenche le but que cette thèse se pose de poursuivre sur le plan de la pensée théologique-pastorale: elle veut accompagner l’Église en son être à l’intérieur de cette tension entre l’instance théologique d’une foi qui est «pour tous» et le donné sociologique dont il émerge qu’elle n’est plus «de tous». Beaucoup de projets contemporaines de réforme pastorale ont l’intention de faire face aux transformations de la culture afin d’empêcher tout injustifiée domestication. Cependant, comme cette thèse essaie à le prouver, ils risquent souvent de suggérer une rupture avec le passé récent du corps ecclésial. Pour eux la référence polémique est représentée par cette figure de «catholicisme populaire» avec qui, dans le contexte de la «civilisation paroissiale», l’expérience chrétienne est réussie à s’enraciner dans le tissu social. Dans ces projets, il est – en effet – assimilé d’une manière restrictive à une sorte de «catholicisme de masse», basé seulement sur des processus religieux de socialisation et d’uniformisation de l’expérience. Au contraire, le but de ce travail consiste en un essai de compréhension renouvelée de cette figure de vie chrétienne. Elle n’est retenue seulement selon la particulière forme historique qu’elle a adoptée dans le demain passé, marqué par une situation d’homogénéité culturelle, d’une Église de peuple, mais aussi comme principe opératoire qui désigne la capacité du christianisme de se réaliser en tant qu’élévation et transfiguration des formes anthropologiques de base. Cette perspective dynamique permet de trouver dans le «catholicisme populaire» un principe écclesio-génétique qui exalte l’interaction entre l’initiative ecclésiale et la sensibilité des croyants, et qui, tout en défendant la qualité théologale de l’expérience chrétienne, ne méprise pas la valeur pédagogique de son enracinement religieux. La dynamique qui préside au «catholicisme populaire», grâce à la confrontation avec une étude sur le terrain, conduit à l’individuation de certaines provocations à propos de la structure du corps ecclésial, en ce qui concerne les représentations, les actions, les sujets et les limites qui le caractérisent. Elles sont transposées de manière à envisager une réforme de l’Église qui s’avère applicable pour le présent et qui cherche à garder le caractère universel-non formel de la foi, c’est à dire son «pour tous».
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La synthèse d’un ARNm eucaryotique dépend d’une suite d’étapes qui inclut notamment l’ajout d’une queue poly(A) à son extrémité 3’. Au noyau, la queue poly(A) des ARNms est liée par PABPN1 (poly(A)-binding protein nuclear 1). PABPN1 fut notamment caractérisée, d’après des études in vitro, pour stimuler la réaction de polyadénylation en plus de contrôler la taille ultime des queues poly(A). Cela dit, la ou les fonction(s) biologique(s) de PABPN1 est/sont cependant largement méconnue(s). Chez Schizosaccharomyces pombe (S. pombe), Pab2 est l’orthologue présumé de PABPN1. Or, mes travaux indiquent que Pab2 est fonctionnellement différente de PABPN1 à l’égard de son rôle sur le processus général de polyadénylation. Ainsi, in vivo, l’absence de Pab2 entraîne l’expression et l’accumulation d’un groupe limité d’ARNs hyperadénylés parmi lesquels se trouvent de nombreux petits ARNs nucléolaires non-codants (snoRNAs) lesquels constituent normalement un groupe abondant d’ARN poly(A)-. Mes résultats supportent ainsi un mécanisme par lequel des snoRNAs immatures poly(A)+, sont convertis en une forme mature poly(A)- par le biais de Pab2 et de l’activité 3’-->5’ exoribonucléase de l’exosome à ARN. Ces observations sont inusitées dans la mesure où elles associent une fonction pour une PABP dans la maturation d'ARNs non-codants, contrairement à la notion que les PABPs travaillent exclusivement au niveau des ARNms, en plus de procurer une nouvelle perspective face au mécanisme de recrutement de l'exosome à ARN à des substrats poly(A)+. La formation de l’extrémité 3’ d’un ARN est un processus étroitement lié à la terminaison de sa transcription. Pour les gènes codants, la terminaison transcriptionnelle est initiée par le clivage endonucléolytique du pré-ARNm. Ce clivage génère une extrémité d’ARN 5’ libre laquelle sera ciblée par une exoribonucléase 5'-->3’ afin de mener à bien l’éviction de l’ARNPII de la matrice d’ADN (terminaison transcriptionnelle de type torpedo). Au contraire, chez Saccharomyces cerevisiae (S. cerevisiae), la majorité des gènes non-codants, incluant les snoRNAs, dépendent plutôt du complexe NNS (Nrd1/Nab3/Sen1) pour la terminaison de leur transcription. Cela dit, il est incertain si le complexe NNS est conservé chez d’autres espèces. À cet égard, mes travaux indiquent que S. pombe est dépourvu d’un mécanisme de terminaison de la transcription de type NNS. Seb1, l’orthologue présumé de Nrd1 chez S. pombe, s’associe plutôt à la machinerie de clivage et de polyadénylation et influence la sélection de site de polyadénylation à l’échelle du génome. Mes résultats supportent ainsi l’utilisation de la machinerie de maturation 3’ des ARNms comme principal vecteur de terminaison transcriptionnelle chez S. pombe et identifient Seb1 comme un facteur clé de ce processus. L’évènement transcriptionnel étant hautement complexe, des erreurs peuvent arriver de manière stochastique menant à l’accumulation d’ARNs aberrants potentiellement néfastes pour la cellule. Or, mes travaux ont mis en lumière un mécanisme de surveillance co-transcriptionnel des ARNs impliquant l’exosome à ARN et lié à la terminaison de la transcription. Pour ce faire, l’exosome à ARN promeut la terminaison transcriptionnelle via la dégradation d’une extrémité 3’ libre d’ARN devenue émergente suite au recul de l’ARNPII le long de la matrice d’ADN (phénomène de backtracking). Mes résultats supportent ainsi une terminaison de la transcription de type torpedo inversé (3'-->5’) réévaluant par la même occasion le concept voulant que la terminaison de la transcription s’effectue uniquement selon une orientation 5’-->3’. Somme toute, mes travaux de doctorat auront permis d’identifier et de caractériser plus en détail les facteurs et mécanismes impliqués dans la maturation 3’ et la terminaison de la transcription des gènes codants et non-codants chez l’organisme modèle S. pombe.
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At Mediterranean regions and particularly in southern Portugal, it is imperative to identify grape varieties more adapted to warm and dry climates in order to overcome future climatic changes. Two Vitis vinifera genotypes, Aragonez (syn. Tempranillo) and Trincadeira, were selected to assess their physiological responses to soil water stress. Vines were subjected to four irrigation regimes: irrigated during all phenological cycle, non-irrigated during all phenological cycle, non irrigated until veraison, irrigated after veraison. Predawn leaf water potential was much higher in Trincadeira than Aragonez in non- irrigated plants. This result is in accordance with its higher stomatal control efficiency in this variety (Trincadeira). Photosynthetic capacity (Amax at saturating light intensity) decreased due to stomatal and biochemical limitations under water stress. However, recovery capacity of leaf water status after irrigation was faster in Trincadeira. Yield and yield x Brix increased when irrigation occurred after veraison, particularly in Trincadeira. These results show that Trincadeira presents a drought adaptation than Aragonez. Ratio of variable to maximum fluorescence Fv/Fm and total leaf chlorophyll related with leaf water potential for both species. Reflectance Normalized Difference Vegetation Index (NDVI705), Red Edge Inflexion Point Index and Photochemical Reflectance Index were related with irrigation treatment. Relative water content and specific leaf area were similar between varieties. In conclusion, we suggested that there is variation among the genotypes and the main physiological parameters for variety selection, for drought, were leaf water potential, stomatal conductance and reflectance indexes.
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ABSTRACT The Non-invasive Ventilation represents an alternative from ventilatory support, being frequently used in the treatment of respiratory failure. There are many complications associated with this technique, related to the pressure / air flow and the application of interfaces, being this one the focus of the article. The most appropriate interface selection allows a successful technique; the interface must be based on anatomical characteristics of the patient, cutaneous integrity and ventilation requirements. The Nurse plays a key role selecting the appropriate interface; technical monitoring and prevention of complications. The objective of the study is identify sensitive results to nursing care in the prevention of pressure ulcers (PPU) of the face, in adult and elderly submitted to NIV. This research was through EBSCO (CINAHL (Plus with Full Text) and MEDLINE (Plus with Full Text), with selection of full text articles between 2003-01-01 and 31.12.2013. We used the method of PI[C]O and was selected 13 articles from a total of 353. It was identified a set of specific interventions that prevent the appearing of pressure ulcer (PU), and according to Doran (2011), promotes sensitivity to nursing care results. The nursing interventions in adults with NIV have a direct impact on health outcomes, with preventing and resolving complications, with contribution in terms of effective disease control, adherence to the treatment regimen and consequent increase in life quality.